Provider Demographics
NPI:1902029309
Name:YAO, SIU-LONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SIU-LONG
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 GALLOPING HILL RD
Mailing Address - Street 2:MAILSTOP K-15-3 3200
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1310
Mailing Address - Country:US
Mailing Address - Phone:908-740-4677
Mailing Address - Fax:
Practice Address - Street 1:2015 GALLOPING HILL RD
Practice Address - Street 2:MAILSTOP K-15-3 3200
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1310
Practice Address - Country:US
Practice Address - Phone:908-740-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06647500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0235547Medicaid
NJ0235547Medicaid
NJ179057AHEMedicare PIN